Georgia woman battles HMO's switch from insulin pens to syringes

- Carol Bolton, a Suwanee, Georgia mother of two, says her insulin KwikPen has helped her stay on top of her type 2 diabetes for more than a decade.

"There is nothing to it; it's so easy and quick," Bolton says. "You just take it out of your purse, adjust the insulin level and inject the insulin into your stomach."

Bolton, who is 54, says she's terrified of needles.

But in early December, she says, she got a letter from her HMO, Kaiser Permanente of Georgia, telling Bolton she would have to switch from the insulin KwikPen back to the traditional vials and syringes.

"The only way that Kaiser would continue to cover the pen is if you had Parkinson's, if you're blind, or if you have an amputation," Bolton says the letter explained.

That's a big problem, she says, because she's terrified of needles.

She says she tried injecting herself with the syringes, just to see how it would go.

Bolton says she felt "nervous" and "shaky."

"My hand was shaking," she says, "My blood sugar numbers skyrocketed to the high 200's."

She blames the fear of needles for spiking her blood sugar.

A Kaiser Permanente of Georgia spokesperson declined to discuss Bolton's case with FOX 5 News, but released a written statement saying, "In cases like this, patients are getting the same medicine they were previously getting but administered in a slightly different way. If our patient has a valid reason that he/she cannot take the medicine as prescribed by their physician, they absolutely may work through that with their physician, and even seek another opinion from a Kaiser Permanente physician."

Bolton says she called her primary care provider.

"And I said, 'I'm terrified of needles, I've never had to use the needles, I've always used the pen," she says.

Bolton asked her doctor if there was any way around the switch to the syringes.

"He said no," Bolton says.

A big issue?  The cost of the insulin pen.

Kaiser Permanente's statement continues, "The cost of the device our patients have been using is more than three times that of the prescribed method. In a world of rising health care costs, that number is significant. We are committed to providing our members high-quality, affordable health care.”

But Bolton's husband David says cost shouldn't be the only factor.

"If it's a medical breakthrough and pretty much everyone uses it, why would you want to go back to the stone age of insulin with a bunch of needles and vials," David Bolton asks.

Carol Bolton says the letter from Kaiser Permanente arrived with just two weeks left in the open enrollment period.

The Boltons had purchased her insurance in late 2017 on the insurance healthcare exchange.

"So that's when we make the decision to switch back to Blue Cross Blue Shield," David Bolton says.

Carol Bolton's new plan is a little more expensive, but it covers the KwikPen.

Georgia State Representative Sharon Cooper plans to reintroduce a bill in the upcoming state legislative session setting guidelines for when a company's step therapy protocol can be overridden. She claims in the bigger picture the cost to the healthcare system of not taking medicine properly or at all is significant.

 

Below is the full statement from Kaiser Permanente:

 

“We cannot comment on any specific patient due to federal privacy laws.  At Kaiser Permanente, our No. 1 goal is to provide high-quality care for our members. Our physicians work closely with patients to develop individual treatment plans to help ensure the best possible care. In cases like this, patients are getting the same medicine they were previously getting but administered in a slightly different way. If our patient has a valid reason that he/she cannot take the medicine as prescribed by their physician, they absolutely may work through that with their physician, and even seek another opinion from a Kaiser Permanente physician. In addition, the cost of the device our patients have been using is more than three times that of the prescribed method. In a world of rising health care costs, that number is significant. We are committed to providing our members high-quality, affordable health care.”

 

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